Dr. Len's Cancer Blog

Expert perspective, insight and discussion

It isn't much of a road, really. A single lane gravel covered path through the National Forest near our home in North Georgia. It isn't a grand road, like an interstate where cars go about their business at 70 MPH or more, or large trucks haul their goods from coast to coast. It isn't a grand boulevard, like Park Avenue in New York or Michigan Avenue in Chicago.

No, it's just a country road. But for me, it's a beautiful road. It's a place to take a long walk pretty much undisturbed, especially on a Thanksgiving Day like today. It's a road through hardwoods that have lost most of their leaves, which make a beautiful reddish brown canopy on the forest floor, awaiting the inevitable decay that comes with winter. The pine trees and the holly bushes stand their green guard, awaiting the spring when the oaks, mountain laurel and rhododendron will make their reappearance to joys of many.

This morning was an especially pretty time to take a walk along the road. It was cold (32 degrees), the sky was covered in mist, with puffs of smoke rising from the river that runs along much of my path. As the sun rose, the mist gave way to cloudless blue skies, with the sound of the overnight frost dripping water onto the leaves of the trees below. And the river made its gurgling sound, occasionally punctuated by the report of a hunter's rifle.

The announcement today from Canada that women should severely curtail their use of screening mammograms for the early detection of breast cancer and discontinue regular clinical examinations and self-breast examinations was interesting in and of its own. But the editorial that accompanied that announcement-from a long-time avowed skeptic of the benefits of screening mammograms-took the debate to a new level. Whether that level was higher or lower is a matter of personal interpretation, but in the editorial was the statement that abandoning breast cancer screening is the most effective way we have to reduce the risks of breast cancer. The statement, highlighted in an accompanying press release (http://www.eurekalert.org/pub_releases/2011-11/cmaj-nbc111611.php) was, in short a stunner.

What is even more amazing is that there hasn't been much reaction to that statement. And keep in mind that just two days earlier, the medical journal The Lancet published a letter from an international group of experts in breast cancer screening who raised the issue of an organized anti-mammography campaign orchestrated in part by the head of the Nordic Cochrane Centre, headed by none other than the physician who wrote the editorial. But from where I sit-a place that is usually the epicenter of these discussions-there has in fact been very little reaction. No media, no frantic calls, no running to man the barricades. Essentially, nothing.

I find that hard to understand for a story with this degree of impact. Maybe we are all just worn out from the screening debates, after several years of indecision about the benefits of mammograms, the frequency of pap tests, and the big debate recently about whether or not prostate cancer screening really saves lives.

For me and others I know, there is increasing concern that the value of screening for the prevention and early detection of cancer will get lost in the morass of conflicting comments, and that we might be at risk of turning off the public to the benefits of screening for cancer, and perhaps lives will be lost in the process. And that would be shameful. More...

This announcement culminates a highly watched process where the FDA determined that although it had granted accelerated approval for the use of this drug in treating breast cancer, subsequent studies did not demonstrate in any group of women that Avastin® actually helped patients in any meaningful way, while causing significant harms-including death.

In the accelerated approval process, the FDA permits a company to market a drug for a specific indication, usually in a life threatening disease, while allowing the company to perform additional trials to confirm the value of the drug. After those trials are done, under this form of approval, the FDA reserves the right to revoke that approval if the original promise of the drug is not confirmed. That is what has happened with Avastin® in breast cancer.

As difficult as this decision has been for the FDA, it is even more difficult for women (and their loved ones and their doctors) who believe that Avastin® has saved their lives. The Commissioner emphasized that she was acutely aware of that concern in making her determination, but she underlined the fact that when the science was carefully reviewed, there was no evidence of meaningful benefit of Avastin® in breast cancer treatment.

The full impact of this decision is difficult to determine at this time. More...

Thanksgiving is just a week away (go turkey!!!), which means today is the American Cancer Society's annual Great American Smokeout (or GASO for short). In fact, 2011 is the 36th year for the Smokeout, which makes it a longstanding (and successful) tradition in our world.

What, you may ask, is GASO?

Well, GASO is a day to focus on the opportunity--if you are a smoker or know someone who is--to make a commitment to quit, or perhaps a day to choose as your "quit day" if you were alert enough to plan ahead. It is a day when you can take a step that could be one of the most important ones you can make, a pledge to do something which could be the single greatest thing you can do for your health, a day to reduce your risk of death from cancer and many other diseases related to smoking.

Quitting isn't easy. We all know that. Cigarettes and other forms of tobacco are among the most addicting substances we can take into our bodies. And the sad reality is that if you decide to smoke, the chances are about 1 in 2 that smoking will have a role in causing your death. And to make matters even worse, that death is likely to be premature.

In fact, every year in this country, 443,000 people die from tobacco related illnesses. More...

As you know, my posts to the blog have been missing in action for the past several weeks. Nothing bad or wrong, mind you. Just lots of travel, lots of meetings, lectures and getting to know some very wonderful people across the country.

So I am sitting here on a Sunday afternoon, trying to catch up on emails while attending yet another meeting (yes, on a Sunday. Maybe it's time to get a life). And I came across the message below about our Hope Lodge in Manhattan which celebrated its fourth anniversary this past week. And when you think about it, it is a very special story: More...